Provider Demographics
NPI:1659549897
Name:BOLTON, ELIZABETH ANN (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:BOLTON
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 ROWLAND DR.
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503
Mailing Address - Country:US
Mailing Address - Phone:434-420-1049
Mailing Address - Fax:434-319-5334
Practice Address - Street 1:302 ROWLAND DR.
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503
Practice Address - Country:US
Practice Address - Phone:434-420-1049
Practice Address - Fax:434-319-5334
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202001018235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist